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Cardio - Gupta > Blood Vessels - The Basics > Flashcards

Blood Vessels - The Basics Flashcards

1
Q

T or F: maintanace of a non-thrombotic state is dependent on laminar flow

A

True, Laminar Flow is required to prevent thrombosis

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2
Q

What are some basic relaxing and contracting factors secreted from the endothelial lining of vessels?

A

Relaxing - Nitric Oxide

Contracting - Endothelin

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3
Q

In what conditions might tight junctions become more permeable?

• how are large amounts of solutes moved?

A
  • Vasoactive Agents Secreted or High Blood Pressure will increase the tight junction permeability
  • Large Amount of Solute moved by Trancytosis
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4
Q

What are the Two Mechanisms of Vascular Pathology?

A
  1. Narrowing or Obstruction
  2. Weaking (resulting in aneurysm
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5
Q

What vascular pathology has happened here?

A

Dissecting Aneurysm

• Media has been split in half

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6
Q

What vascular pathology has happened here?

What time frame did it happen in and how do you know?

A

Acute Narrowing/Obstruction of a vessel

• You can see lines of Zahn indicating that it is a thrombus, clefts of cholesterol indicating that Hypercholesterolemia could be etiology

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7
Q

What vascular pathology has happened here?

• what has caused it, time frame?

A

Narrowing of Vessel Lumen as a result of intimal thickening can be seen

• More progressive than just acute, resultin from high LDL over a long period of time

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8
Q

What has happened here?

A

Atherosclerotic aneurysm from Weakening of BVs

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9
Q

What is Glycation?

• Diseases where it is common?

A

Glycation - non-enzymatic reaction between reducing sugars such as glucose and proteins, lipids, or nucleic acids

**Common in Diabetes, we use Hbg A1C**

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10
Q

What is glycoxidation?

A

When OXIDATIVE steps are involved ine Glycoxidation

**ROS accelerate this processes

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11
Q

What is a time when you might not want to measure Hbg A1C in a patient?

A

People who don’t have much Hbg A1 such as Sickle Cell patients or Pts. with alpha thalessemia

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12
Q

In what 3 ways do Advanced Glycation End products (AGEs) contribute to vascular disease?

A
  1. Collage Crosslinking promoted
  2. Glycation of LDL
  3. Binding to RAGE
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13
Q

How does promotion of collagen cross-linking lead to increased cardiovascular disease?

A
  • Collagen Crosslinking causing Stiffening of Vascular Walls
  • Crosslinking also causes entrapment of LDL in the artery walls
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14
Q

How does glycation of LDL promote CV disease?

A
  • Glycation of LDL makes it more prone to get oxidized
  • Oxidation of LDL is a MAJOR risk factor of Atherosclerosis
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15
Q

How does binding to RAGE (receptor for advanced glycation end products) lead to CV disease?

A
  • Binding to RAGE promotes Oxidative Stress on the Endothelium
  • Also activates Inflammatory Pathways in the endothelial cells
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16
Q

What 3 congenital Anomalies do we need to know for vessels?

A
  • Berry Aneurysms
  • Arteriovenous (AV) fistulas
  • Fibromuscular Dysplasia
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17
Q

Berry Aneurysms

  • What are they?
  • Where are they found?
  • Why does it happen?
  • Dangers?
A

What/Where:

• Thin-walled arterial outpouching in cerebral vessels specifically at Branch Points

Why:

• Media is CONGENITALLY too thin (attenuated)

Danger:

• Rupture

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18
Q

What is the major complaint of someone experienceing a Berry Aneurysm?

A

“The worst headache I’ve Ever had”

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19
Q

****What is this?

• What do you think this person complained of when they came to the ED?

A

Berry Aneurysm - caused by a congenitally thin media

• Probably Said it was the worst headache they’ve ever had

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20
Q

What is an Arteriovenous (AV) fistula?

• Whats a major problem that may result?

A

• CONGENITAL Abnormal connection between an Artery and a Vein (they don’t go all the way down to capillaries, they just connect)

Major Problem: Susecptible to Hemorrhage and Hypoxia even without Hemorrhage from decreased Surface area of vessel being exposed

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21
Q

*****What has happened here?

A

AV Fistula - caused by direct connection between an artery and a vein

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22
Q

Fibromuscular Dysplasia

  • What is it?
  • Type of Vessels Affected?
  • Who is it found in?
A
  • Congenital disease causing alternating thickened and thinned arterial walls usually from thickening of the Media
  • small to medium sized vessels are affected
  • Found in younger women
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23
Q

A young fit woman comes in with hypertension as a result of Fibromuscular Dysplasia.

  • What is the most likely cause of the HTN?
  • Other risk factors of the disease?
  • APPEARANCE?
A

Cause - hypertension can be caused in patient with Fibromuscular Dysplasia via renal artery constrictions

Other Disease Complications: 10% experience medial dissections

Beads on a String Appearance in affected vessels

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24
Q

****T or F: thickening in this vessel was caused by either an inflammatory or atherosclerotic process.

A

False, this is from a patient with fibromuscular dysplasia - these patients experience non-inflammatory, non-atherosclerotic thickening of the media

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25
Q

T or F: PRIMARY vascular tumors of large vessels are fairly comon and are often carcinomas

A

FALSE, they are EXTREMELY RARE and are usually SARCOMAS

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26
Q

What are vascular tumors that arise from the endothelium called?

• what about ones from support cells?

A

Hemangiomas or Angiosarcomas

Support Cells = Glomus Tumor

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27
Q

Compare Benign and Malignant Tumors with respect to:

  • Organization
  • Cellularity
A

Benign:

  • Obvious Vascular Channel with Blood
  • Lined by monolayer of normal appearing cells

Malignant:

  • poor orgnaization of vessels
  • more cellular with cytologic atypia
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28
Q

What markers can you use to confirm that the tissue you’re looking at is in fact vascular?

A
  • CD31
  • CD34
  • D2-40
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29
Q

What is a vascular ectasia?

A

• Local Dilation of a Blood Vessel

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30
Q

What are the 3 benign vascular ectasias?

A
  • Nevus Flammeus
  • Spider Telangectasias
  • Hereditary Hemorrhagic Telangectasia
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31
Q

What is a Telangiectasia?

• where is it usually found?

A
  • Telangiectasia - permanent dialation of small BVs
  • Typically occurs in mucous membranes and skin
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32
Q

T or F: Vascular ectasias are very benign neoplasms

A

FALS, these are NOT TRUE NEOPLASMAS

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33
Q

Nevous Fammeus

  • Typical Appearance
  • Progression
  • Life impact
A

aka port wine

Appearance

• Large Flat patch of purple or dark red skin with well defined borders

Progression

• Starts off flat at birth but become more bumpy and unsighly over time and DOES NOT REGRESS

Life Impact:

• Not any real health impact but the psychosocial element may be huge

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34
Q

****What is this?

• What is the Px?

A

Nevus Flammus

• No real health impact, BUT they should expect that this will be a long term condition with a high probability of having a psychosocial impact

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35
Q

Salmon Patch

  • Typical Appearance and Location
  • Progression
  • Life Impact
A

Appearance:

• typically on back of neck (stork bite) or between eyes (angels kiss)

Progression:

• Unlike nevus flammeus will regress over 1st year of life

Life Impact:

• prolly none

36
Q

****What condition is this?

• What is the Px?

A

Condition - Naevus Simplex aka salmon patch

• will regress in the 1st year of life

37
Q

Sturge-Webber Syndrome

  • Physical appearance?
  • Effects on Brain?
A

Physical Appearance:

• port wine in the trigeminal distribution

Brain Effects:

  • ipsilateral venous angiomas in the leptomeninges
  • ^ causes - mental retardation, seizures and hemiplegia
38
Q

****What condition does this baby likely have?

• What is the Px?

A

Sturge-Weber Syndrome - because the port wine stain follows the trigeminal distribution

Px: Poor - this often causes Ipsilateral Hemangiomas on the leptomeninges that can result in mental retardation, hemiplagia, and siezures

39
Q

****What benign Vascular Ectasia may have caused this appearance on CT?

A

Sturge-Weber Syndrome - hemangiomas in the meninges causes asymmetry and blood on the brain as seen on the right side of the picture (left frontal lobe)

40
Q

****What is this?

•what are some possible risk factors?

A

Spider Telangectasias

Risk factors: HYPERestrogen states - Pregnancy, or Cirrhosis (alcoholics)

41
Q

****What is this condition?

• What is the most likely cause?

A

Erythemia ab igne (EAI)

caused by Infrared Radiation in the form of heat

*Think about a kid who has been sitting next to a heater or sitting with your laptop on your legs for too long

42
Q

***What is this?

A

Classic basal cell carcinoma

43
Q

Hereditary Hemorrhagic Telangiectasia

  • Inheritance?
  • Mutation?
  • Most common symptom?
A

Inheritance:

• Autosomal Dominant

Mutation:

• Most commonly in the TGF-beta gene

Symptoms:

• Recurrent nosebleeds, GI bleeds can also be problematic

44
Q

*****What condition is this?

• Treatment?

A

Hereditary Hemorrhagic Telangiectasia

• Only treated symptomatically - G.I. bleed etc.

45
Q

Lymphangitis

• What is it?

A

Infection uses vasculature (lymph, veins, etc.) to travel into the body

46
Q

****What condition does this patient have?

A

lymphangitis

47
Q

How common is Nevus Flammus compared to Salmon Patch?

A

Salmon Patch is much more common

48
Q

Hemangiomas

  • How common?
  • Composition?
  • Benign or Malignant?
A
  • Very Commmon
  • Composed of Blood-Filled Vessels
  • BENIGN - only a low chance of becoming malignant
49
Q

****What is this?

A

Hemangioma

50
Q

What 4 types of Hemangioma are there?

• Which is most common?

A
  • Capillary Hemangioma
  • Juvenile Hemangioma (aka Strawberry Hemangioma)
  • Pyogenic Granulomas
  • Cavernous Hemangioma
51
Q

Capillary Hemangioma

  • Frequency?
  • Location?
  • Histological Features?
A

Most Common Hemangioma

Found in Skin and SubQ, Mucous Membrane, may occasionally be in Liver, spleen, or kidney

Histo: Thin Walled, Scant Stroma

***Note: this is more likely a transformation than a neoplasm

52
Q

****What condition is this?

• What histological features are you looking for?

A

capillary hemangioma

Thin walled with Scant Stroma, Endothelial Lining with NO MITOSIS

53
Q

Juvenile Hemangiomas (strawberry hemangiomas)

  • Number typically present?
  • Who are they usually seen on?
  • Px?
A
  • Can be one or multiple present
  • Seen on newborns
  • rapid growth for 1 to 3 years followed by regression by age 7
54
Q

Histological Features of Juvenile Hemangiomas

A
  • Endothelial Cells that line vascular spaces. These have small lumens (hard to see)
  • mitotic figures are common (may be multiple)
  • Mast Cells are present
55
Q

****What condition is this?

• Px?

A

Juvenile (strawberry) Hemangioma

• Tumor will grow years 1-3 then regress by age 7

56
Q

****What condition is this?

A

Strawberry Hemangioma

  • Endothelial Cells that line vascular spaces. These have small lumens (hard to see)
  • mitotic figures are common (may be multiple)
  • Mast Cells are present
57
Q

Pyogenic Granulomas

  • Appearance (gross and histological)
  • Location/onset
  • Pain
A

Appearance/Location

  • Pedunculated appearance often in areas of trauma and common during pregnancy
  • Histologically looks like granulation tissue

Pain:

• Often Painless

58
Q

****What is this?

A

Pyogenic Granulomas

• Appears like granulation tissue, small slits correspond to capillaries

59
Q

****What is this?

A

Pyogenic Granulomas (type of capillary hemangioma)

60
Q

Cavernous Hemangioma

• ability to infiltrate?

• Regression?

A

Infiltration:

• More likely to infiltrate than the other capillary hemangiomas

Regression:

• Does not regress

61
Q

***What is this?

A

Cavernous Hemangioma

• scant stroma

• Tons of Blood

62
Q

***What is this?

• Px?

A

Cavernous Hemangioma

will not regress

63
Q

What syndrome is associated with Cavernous Hemangiomas?

A

Von Hippel-Lindau Syndrome

64
Q

Simple Lymphangioma

• commonly found where?

• Histological Characterisitics

A
  • Found most commonly in head neck and axilla
  • NO RBCs in histological section
  • Typically 1-2 cm
65
Q

Cavernous Lymphangioma (cystic hygroma)

  • Location
  • Disease associations
A
  • Located on Neck or in Axilla
  • Presents as more of a cystic mass than simple lymphangiomas
  • Associated with Turner syndrome
66
Q

*****What is this?

A

Lymphangioma

*must use Hx to determine if its simple capillary lymphangioma or a cavernous lymphangioma

67
Q

****What is this?

A

Cavernous Lymphangioma (cystic Hygroma)

68
Q
  • What are some characteristics of Turner Syndrome?
  • Genetic defect?
A
  • Webbed Neck
  • Far Spread Nipples

**Caused by XO chromosome

69
Q

Glomus

• Cell type responsible?

  • Benign or Malignant?
  • Location?
  • Pain?
A
  • Cell type = glomus body cells that are needed for thermoregulation (specialized smooth muscle)
  • Benign tumor found under the nail
  • These are often very painful
70
Q

****What tumor type is this?

• benign or malignant?

A

Gloumus - Benign

*looks like endothelial cells are spiralling off the vessel

71
Q

****what tumor is this likely to be?

A

Glomus but melanoma should be in your differential

72
Q

Bacillary Angiomastosis

• what is it?

  • organism responsible
  • tissue type involved
A

What is it?

• Vascular Proliferation

Tissue:

• Skin, Bone, Brain, other - Pretty much any type

Organisms Responsible:

  • Bartonella henselae - found on cats
  • Bartonella quintana - transmitted by body lice
73
Q

How do bacteria cause Bacillary Angiomatosis?

A

• They induce HIF-1alpha

***note: these are gram negative bacteria

74
Q

****What is this?

A

Bacillary Angiomatosis

75
Q

Kaposi’s Sarcoma

  • How does HHV-8 induce cancer?
  • Stages of Kaposi’s
A

• HHV-8 prevents apoptosis by inhibiting p53

Stages:

  • Patches - pink, red or purple typically on distal leg
  • Plaque - larger, raised
  • Nodular - may involve viscera
76
Q

***What is this?

A

Patch phase of Kaposi’s Sarcoma

77
Q

***What is this?

A

• Plaque Phase of Kaposi’s Sarcoma

78
Q

***What is this?

A

Nodular Phase of Kaposi’s Sarcoma

79
Q

Angiosarcoma

• Most commonly seen in?

  • Seen where?
  • Px?
A
  • Most commonly seen in older people, but younger people who get diagnosed have a better px
  • Most commonly seen in Skin, Soft Tissue, Breast and Liver but others are possible
  • on 30% 5 year survival rate
80
Q

****What is this?

A

Lymphangiosarcoma

81
Q

****What is this?

A

Angiosarcoma

82
Q

****what is this?

A

Angiosarcoma of the breast

83
Q

What causes angiosarcomas of the liver?

A

PVC (polyvinyl chloride)

Thorotrast (radioactive contrast dye)

Arsenic Pesticides

84
Q

What type of women often present with angiosarcoma of the breast?

A

• Women who undergo radiation chemo treatment

• If long term indwelling foreign bodies are in the breast

85
Q

***What is this?

A

Stasis Dermatitis

Cardio - Gupta (12 decks)

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